Provider Demographics
NPI:1134902331
Name:POOL-DONAHUE, FALLON LAVAE
Entity type:Individual
Prefix:
First Name:FALLON
Middle Name:LAVAE
Last Name:POOL-DONAHUE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:847 SUMPTER RD
Mailing Address - Street 2:
Mailing Address - City:VAN BUREN TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48111-4905
Mailing Address - Country:US
Mailing Address - Phone:313-802-8220
Mailing Address - Fax:
Practice Address - Street 1:1120 WOODGLEN AVE
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48198-6216
Practice Address - Country:US
Practice Address - Phone:304-561-7737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care